summary: Researchers have found that taking a daily antioxidant supplement slows the progression of late-stage dry age-related macular degeneration (AMD). The supplement helps preserve central vision by slowing the expansion of areas of geographic atrophy in the retina. This finding supports the use of AREDS2 supplementation for patients with late-stage dry AMD.
Key Facts:
- Benefits of the supplement: AREDS2 supplement slows the spread of geographic atrophy by 55%.
- Research details: The analysis included 1,209 eyes from the AREDS and AREDS2 trials.
- Preserving Vision: Antioxidants help preserve central vision in late-stage dry AMD.
sauce: NIH (National Institutes of Health)
In a new data analysis, researchers at the National Institutes of Health (NIH) have found that taking a daily supplement containing antioxidant vitamins and minerals may slow the progression of late-stage dry age-related macular degeneration (AMD) and help patients with the end-stage disease preserve central vision.
The researchers examined original retinal scans from participants in the Age-Related Eye Disease Studies (AREDS and AREDS2) and found that in patients with late-stage dry AMD, taking antioxidant supplements slowed the expansion of the area of geographic atrophy toward the foveal region of the retina.
The study was published in the journal Ophthalmology.
“We have known for some time that AREDS2 supplementation can help slow the progression of intermediate to late AMD, and our analysis shows that taking AREDS2 supplementation can also slow disease progression in patients with late-stage dry AMD,” said Tiernan Keenan, M.D., Ph.D., of the NIH’s National Eye Institute (NEI) and lead author of the study.
“These findings support the continued use of AREDS2 supplements by patients with late-stage dry AMD.”
In the new analysis, the researchers looked at the original retinal scans of participants in the AREDS (318 participants, 392 eyes) and AREDS2 (891 participants, 1,210 eyes) who developed dry AMD and calculated the location and growth of areas of geographic atrophy.
For people with geographic atrophy in the central field, the supplements had little effect, but for the majority of people with geographic atrophy far from the fovea, the supplements slowed the rate of growth of atrophy toward the fovea by about 55% over an average of three years.
In early and intermediate AMD, small yellow deposits of fatty proteins called drusen form on the light-sensing retina at the back of the eye. As the disease progresses to later stages, blood vessels may become leaky (“wet” AMD) and some of the light-sensing cells in the retina may be lost (“dry” AMD). The geographic atrophy in these areas slowly increases over time, causing a gradual loss of central vision.
The original AREDS trial found that a supplement combination containing antioxidants (vitamins C, E, and beta-carotene), zinc, and copper could slow the progression of intermediate to late stage AMD.
The subsequent AREDS2 trial found that substituting beta-carotene for the antioxidants lutein and zeaxanthin improved the supplement’s efficacy and eliminated certain risks. At the time, neither trial detected any additional benefits after participants developed terminal disease.
However, this initial analysis did not take into account a phenomenon called “foveal sparing” in the dry form of late-stage AMD. Although all areas of the retina are sensitive to light, the area where central vision is most acute is called the fovea.
Many patients with atrophic AMD first develop geographic atrophy outside the foveal region, and only lose central vision when the area of geographic atrophy spreads into the foveal region.
“Our high acuity central vision is essential for tasks such as reading and driving. Given that patients with end-stage dry AMD have few treatment options to preserve or restore vision, antioxidant supplementation is a simple step that may slow the decline of central vision, even in patients with end-stage disease,” Keenan said.
“We plan to confirm these results in a dedicated clinical trial in the near future.”
Funding:
Study authors include Keenan, Elvira Agrón and Emily Chew, MD, PhD, of NEI; Pearse Keane, MD, PhD, of Moorfields Eye Hospital in the UK; and Amitha Domalpally, MD, PhD, of the University of Wisconsin-Madison. This research was supported by the NEI Intramural Research Program.
Funding for the AREDS and AREDS2 studies was provided by the NEI and the NIH Office of Dietary Supplements, the National Center for Complementary and Alternative Medicine, the National Institute on Aging, the National Heart, Lung, and Blood Institute, and the National Institute of Neurological Disorders and Stroke under contract numbers NOI-EY-0-2127, HHS-N-260-2005-00007-C, and N01-EY-5-0007.
The AREDS and AREDS2 studies (clinicaltrials.gov numbers NCT00000145 and NCT00345176, respectively) were conducted at the NIH Clinical Center.
About this AMD and visual neuroscience research news
author: Leslie Earl
sauce: NIH (National Institutes of Health)
contact: Leslie Earl – NIH
image: Image courtesy of Neuroscience News
Original Research: Open access.
“Oral antioxidant and lutein/zeaxanthin supplements slow progression of geographic atrophy to the fovea in age-related macular degeneration” by Tiarnan Keenan et al. Ophthalmology
Abstract
Oral antioxidant and lutein/zeaxanthin supplements slow progression of geographic atrophy to the fovea in age-related macular degeneration
the purpose
To update the Age-Related Eye Disease Study (AREDS) Simplified Severity Scale for late-stage age-related macular degeneration (AMD) risk, including incorporation of reticular pseudosinuses (RPD), and to perform external validation in the Age-Related Eye Disease Study 2 (AREDS2).
design
Post hoc analysis of two clinical trial cohorts, AREDS and AREDS2.
participant
Participants were free of late AMD in both eyes at baseline in AREDS (n = 2719) and AREDS2 (n = 1472).
Method
Five-year progression rates to late AMD were calculated according to levels 0 to 4 of the Simplified Severity Scale after two updates. (1) Non-central geographic atrophy (GA) was considered part of the outcome rather than a risk characteristic, and (2) the scale was separated according to RPD status (determined by validated deep learning grading of color fundus photographs).
Main Evaluation Items
Five-year rate of progression to late AMD (defined as neovascular AMD or GA).
result
In AREDS, after the first scale update, the 5-year progression rates to late AMD for levels 0 to 4 were 0.3%, 4.5%, 12.9%, 32.2%, and 55.6%, respectively. For the final abbreviated severity scale, the 5-year progression rates for levels 0 to 4 in participants without RPD at baseline were 0.3%, 4.3%, 11.6%, 26.7%, and 50.0%, respectively, and for participants with RPD at baseline, the 5-year progression rates for levels 0 to 4 were 2.8%, 8.0%, 29.0%, 58.7%, and 72.2%, respectively. In external validation of AREDS2, progression rates from level 2 to 4 were similar: 15.0%, 27.7%, and 45.7% (without RPD) and 26.2%, 46.0%, and 73.0% (with RPD), respectively.
Conclusion
The AREDS AMD Simplified Severity Scale has been modernized with two important updates. For individuals without RPD, the 5-year progression rates of the new scale are approximately 0.5%, 4%, 12%, 25%, and 50%, maintaining the accuracy of the original scale. For individuals with RPD, the 5-year progression rates of the new scale are approximately 3%, 8%, 30%, 60%, and 70%, approximately double at most levels. The scale fits the updated definition of late AMD, improving prognostic accuracy and likely generalizing to similar populations, while remaining simple for broad risk classification.
Financial Disclosure
Any proprietary or commercial disclosures are set out in the footnotes and disclosures at the end of this article.
